• Eric Noll, Ludovic Keller, Tran Ba LocPierrePDepartment of Public Health, Strasbourg University Hospital, France., Philippe Adam, Thomas Arat, Johanne Piotrowski, Elliott Bennett-Guerrero, Erik Sauleau, and Julien Pottecher.
• Department of Anesthesiology and Intensive Care, Hautepierre Hospital, Strasbourg University Hospital, Service d'Anesthésie-Réanimation, 1 avenue Molière, Strasbourg 67200, France. Electronic address: eric.noll@chru-strasbourg.fr.
• Injury. 2023 Aug 1; 54 (8): 110813110813.

BackgroundEarly hip fracture surgery is recommended to decrease mortality, however the impact of a delay in surgery due to previous treatment with direct oral anticoagulants (DOA) is unknown. Our objective was to determine if early surgery, defined as surgery within 48 h of hospital admission is associated with decreased postoperative mortality. We tested the hypothesis that early surgery was beneficial with regard for mortality in patients treated with direct oral anticoagulants.MethodsRetrospective cohort study in a French University Hospital including patient admitted for Hip fracture. The main exposure was wait time for surgery defined as the total time, in hours, between hospital admission and surgery. The main outcome was mortality within 30 days after hip fracture surgery.ResultsIn 3429 patients, the overall 30-day mortality was 4.1% (95% CI 3.5%; 4.9%). In DOA + patients, the 30-day mortality rates in the early and delayed surgery groups were 1.2% and 5.9%, respectively, with estimated risk difference of -4.4 (with a 2% probability of this difference is > 0). In the DOA + group, early surgery tended to be associated with a higher percentage receiving red-blood cells (64.6% vs 54.8%, respectively, estimated risk difference of 9.9% with a 93% probability of this difference is > 0) and lower risk of pneumonia (1.2% vs 8.2%, respectively; estimated difference of -6.7% with 0.3% probability of superiority).ConclusionEarly hip fracture surgery was associated with improved survival in patients previously treated with DOAs.Copyright © 2023. Published by Elsevier Ltd.

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